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Menopause

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234vhh · 22/08/2023 11:08

NeverDropYourMooncup · 21/08/2023 17:42

If women have been convinced that their symptoms of joint pain, swelling, tiredness, skin itching and feeling like they've been through a cement mixer filled with bricks every morning when they wake up can only be due to their ovaries shutting up shop, rather than being an autoimmune disease that can be easily treated with DMARDs or biologics, no wonder they're still feeling shit and think 'It can't be a high enough dose'.

If they're actually justifiably unhappy, tired and emotional because they're in a crappy relationship, their kids are being horrid, their boss is piling more and more work and rules onto them with constant criticism rather than giving them respect and greater autonomy and it isn't because they are mere hormonal beasts of burden in need of more magic estrogen, no wonder they're still feeling shit and think 'It can't be a high enough dose'.

If they're actually undiagnosed with ADHD and are completely burned out from trying to function despite their missing diagnosis, but have been convinced that it's all your age, dear, no wonder they feel like crap and think it can't be a high enough dose.

If they're actually malnourished because they're trying to keep their weight as low as possible for 30 years or because they are so skint and tired, they've had to rely upon cheap, low nutrition food for years, their bone density is abysmal, their iron levels are low, they're chronically deficient in Vitamin D and experiencing osteomalacia as a precursor to osteoporosis, but it's been blamed on her age and hormones rather than a desperate need to improve nutrition, no wonder they feel like crap and think it can't be a high enough dose.

Whilst Davinia McShouty makes an absolute fucking shedload out of writing everything off as withering ovaries instead of social, economic, interpersonal and genuine physical conditions that can be relieved if they are actually investigated and treated instead of dismissed as being due to getting on a bit, no wonder women still feel like crap and think it can't be a high enough dose.

And sometimes it isn't a high enough dose. But there is more to women's lives and health than the level of hormones their ovaries are secreting. Easy to write them all off, though, isn't it?

This is fucking bang on the money. Love this post.

Original poster
cyclamenqueen · 22/08/2023 12:30

But this comes back to my point that women are just not supported by the medical profession. I had to have hip surgery a few years ago , I was made to have nearly a year of useless physio. Useless because my issue could not be fixed with physio, finally we went private saw a specialist had the surgery. When I came round the nurse said they were amazed I was was walking and that they had men in with 1/10 of the impingement that I had. Bet they didn’t have to have a year of physio to prove it was really painful.

Women are routinely not listened to and offered anti depressants for everything, so just as they do in their everyday lives, they take things into their own hands. From that point of view the author is right, many people probably are on the wrong dose , but why is it that woman have embraced this so wholeheartedly and what does it say about the quality of medical care available to women. Interestingly when viagra started to be prescribed there was no outcry about the overprescribed /incorrect dosages then was there ?

OP posts:
JinglingSpringbells · 22/08/2023 12:46

I'm actually really surprised at this article. It comes over as one female GP who has specialised in menopause, and is doing some private work alongside her NHS work, taking a bit of a swipe at another female GP who has done the same (and maybe more successfully in terms of business development) by using her role as chair of the BMS.

I am confused about the way she discusses blood tests for estrogen levels as a renowned menopause gynaecologist told me that they are often inaccurate.

If nothing else, it shows there are many differing opinions amongst doctors.

I agree that HRT doesn't sort out everything, but I don't think women are so stupid to believe it does. There are still only around 10-15 % of women using HRT so the 'Davina effect' isn't there as much as we think.

If someone's relationships aren't working, or they hate their job, or are having issues with loads of other things, HRT won't provide the solution. But it may help them sleep better and feel more able to cope and find the right support for other issues, and give them a bit of motivation to exercise or improve their diet etc.

Sortmylifeout52 · 22/08/2023 12:57

PB is my menopause specialist.
I've always found her honest and flexible in her approach , regarding what HRT I need.

She definitely has a " less is more" type of approach towards the dosing of HRT and doesn't advocate it as the " cure for all symptoms/ life problems.

I suppose some women get desperate and want their lives fixed. I get that, as it can be hard to fathom out what symptoms are caused by low oestrogen and what are implicated by general life issues. Particularly if you have been on HRT a while.

summerytop · 22/08/2023 23:21

There's definitely a narrative nowadays - prevalent on MN- that you absolutely should go on HRT. Nice to see this article for some balance. Women are overburdened, and many won't have recovered from all the extra stress of the pandemic, through which many worked, supported and cared for families, and everything else. People can't afford decent food and decent rest and time off. All the focus on HRT closes down debate or awareness of other issues at middle age.

KatyMac · 23/08/2023 10:56

Well I had to fight to get hrt, then fight to get the right hrt, then fight to see if a different dose would benefit me

Makes a change from being offered antidepressants at every appointment - sore elbow? Have some antidepressants (I kid you not!)

If hrt is being offered at every turn, could someone tell my surgery please as they are still on the antidepressants kick atm😳🙄

BusinessClass · 23/08/2023 11:14

Why can't women want to feel even better though? Why should we just 'put up' with low doses if higher doses could actually work?

KatyMac · 23/08/2023 20:29

I wonder, do men ever self/over prescribe viagra? That isn't headline news

AnnaMagnani · 23/08/2023 20:49

I don't think this is anti-Davina, I think this is anti-HRT specialists Newson who think everything can be solved with higher doses of HRT.

Newson has done a great job of talking up menopause treatment while giving the impression they are the best for menopause and ground breaking. When actually a lot of clinicians in the menopause community seem to think they are less groundbreaking and more out of synch with everyone else and the science.

When I met my menopause doctor she said 'I don't do Newson' - I didn't know what she meant at the time but I do now.

girlygirly · 23/08/2023 21:04

I am 63. Am I the only person who wasn't ever offered HRT by their GP? I had all the usual symptoms, none of them unmanageable- but the hot flushes were brutal!

I sometimes feel I am, particularly reading MN.

perpetuallybusy · 24/08/2023 12:11

@girlygirly - I wasn't, I'm glad!!

I'm peri and age 42. Symptoms for the past two years include very irregular periods, hot flushes, night sweats, mood swings and various aches and pains.

I went to my GP convinced I HAD to have HRT to protect me from Osteoporosis/ heart disease. He ran a load of 'general' health blood tests like iron, cholesterol etc. Due to my age he wanted to rule out other possible causes.

We talked through the blood test results. We then had a lengthy chat about my diet, lifestyle and why I wanted HRT.

By way of background I'm an endurance athlete and have been for many years. Mainly cycling, but also running. I do some weight training and lots of stretching/ yoga/ pilates. I've also followed a plant based diet for many years. Don't drink, don't smoke. No health issues. I'm a healthy BMI. Blood pressure is good.

He was of the opinion my Osteoporosis risk would be lower than 'average' likewise heart disease risk because of my lifestyle factors. He felt taking HRT (which would likely be a long term thing) for Osteoporosis/ heart disease would be counter productive. He felt even once I've been through menopause my risk for both would probably come down to a more average level. So to take a drug/ synthetic hormone which has other risk factors, albeit small, would therefore be counterproductive.

He was very clear he would prescribe HRT if I wanted it. But, wanted me to think about it... which I did and decided against it. IF my symptoms become unbearable, I will reconsider. But, I can manage them for now. I find exercise helpful for the mood swings, likewise meditation. The yoga etc massively helps my aches and pains. I never used to have aches and pains pre-peri despite training (probably) harder than I train now. The hot flushes weirdly stopped as did the night sweats.

This thread has been quite reassuring in a way. I feel like a bit of a pariah for not taking HRT. It would be helpful for a more holistic approach/ analysis. I was pleasantly surprised by the attitude of my (NHS) GP and the time he took to discuss everything. Whilst I completely get how GPs can be so very dismissive where women are concerned. I do find the general mantra which seems to be pushed (perhaps just on mumsnet? but certainly with the Davina effect) 'you must take HRT' frustrating. I was totally sucked in by it. I'm very glad I was able to have such a productive, measured series of appointments with my GP and make an informed decision. We aren't all the same.

Ichabodandme · 24/08/2023 12:33

@perpetuallybusy Sounds like a fantastic GP!

JinglingSpringbells · 24/08/2023 13:03

@perpetuallybusy It's quite possible that you will have good bone density BUT the only way for you and your GP to be sure is to have the Xray. There is - and it seems counter intuitive- that female athletes can be at a high risk from osteoporosis.

Gynaecologists who work with female athletes at the top (Olympic) level are aware of this and would immediately send you for a DEXA scan.

Something to bear in mind perhaps?

perpetuallybusy · 24/08/2023 13:21

@JinglingSpringbells interesting comments. My understanding was that this is in those whose periods weren't regular (female athlete triad/ undernourished/ over exercised)? I certainly don't fall into this category and never have. Indeed we also know cyclists are significantly more at risk of osteoporosis. This is why I incorporate running and weight bearing exercise in (I started off as a runner, became a cyclist, but kept on doing at least once weekly runs). Interestingly my GP's initial thought was to try and put it down to exercise. Knowing my own body, I know it has nothing to do with it!! For reference I've been previously coached and take a very keen interest in training theory, practice etc. Frustratingly a lot (most) of it is based on male endurance athletes. However, there is material out there based on women. Anyway, I pointed out I'd been training at this level for 20 odd years. I haven't changed anything. There is minimal work or general 'life' type stress. I'm well aware either stresses, on top of my training could send my periods irregular. I've not been in an overtrained state for any length of time (nothing a week off hasn't resolved). I'm rarely ill. So nothing to indicate I'm over doing anything. My sleep is good and long. He accepted it wasn't the exercise!! That isn't the point you raised though. Other than pregnancy (obviously!!) my periods had always been extremely regular, within a window of several days. I'd never missed one and no variation in cycle length. So I wouldn't say the female athlete triad applies to me... therefore not in an 'at risk' category for Osteoporosis?

You are correct though, the only sure way of confirming the educated guess I have good bone density would be a DEXA scan. So this is something I'll be requesting.

JinglingSpringbells · 24/08/2023 13:39

As I said, it's likely your bones are fine but a Dr shouldn't assume that.
Sadly, I know too many friends who have osteoporosis now in their 50s.

I wish DEXA scans were available for all women on the NHS instead of , or as well as, cervical screening, because more women die or are disabled from bone loss than cervical cancer.

Martedi · 25/08/2023 09:17

Reading Mumsnet tends to give the impression that if you’re not on hrt then you’re the equivalent of a chain smoking formula one driver who insists on driving with her eyes closed.

MrsFiddle · 25/08/2023 20:35

My experience of NHS GPs is that most are inadequate when it comes to HRT. They give you HRT then never do any checks apart from the once a year "when are you going to come off it " question.

Sidge · 25/08/2023 20:56

I think that’s a good article.

My GP colleagues (and I) think Newson is - and I quote - a menace. @NeverDropYourMooncup post is spot on.

HRT absolutely has its place and I’d say 75-80% of the women I see need it and benefit from it. The other 20-25%? Not so much. And many of my menopause consultations are about managing expectations.

kizziee · 25/08/2023 22:42

@Sidge I'm surprised that you've said 75-80%. I think I imagined that the 'real' figure is more like 50-60%

Stormydayagain · 26/08/2023 08:34

Are their units of measurements correct in this article?

200pg/ml - 400pg/ml is 734pmol/l - 1468pmol/l
(pmol/l seem to be the standard unit of measurement used in the UK for estradiol).

Newson website recommends aiming for 250pmol/l, my NHS GP stated that she aims for 300pmol/l.

You'd think if you were going to the media not very subtly slagging off your business competitor you'd make sure you or the reporter got the units correct.

Fifireee · 26/08/2023 08:40

It's the Davina McCall/ Mariella Frostropp thing. Celeb women with their own agendas who are confusing the message with trying to flog stuff.
Awareness is one thing but snake oil is another.

I am menopausal but so far managing without HRT. As are most of my friends and family. I know lots of women need it.
I saw one post online which pretty much said you have to take it or you'll get heart disease and dementia.

JinglingSpringbells · 26/08/2023 10:49

kizziee · 25/08/2023 22:42

@Sidge I'm surprised that you've said 75-80%. I think I imagined that the 'real' figure is more like 50-60%

The BMS says that 75% of women have meno symptoms enough to impact on their life, ranging from severe to mild.

How much each woman is willing to put up with the symptoms without hrt is her choice.

No medals for suffering, and none for women not choosing it.

JinglingSpringbells · 26/08/2023 10:56

@Fifireee I wonder if what you read online was this.
Women who have an early or premature menopause (before 45 or 40) are advised to use hrt to prevent heart disease /lower their risks, and also dementia risks.

For women who have a normal menopause around age 50, using hrt for 10 years after their last period is known to lower risk of heart disease. Again, this is now established through medical research over many years.

If you read medical research papers, there is masses of evidence on this and any consultant menopause specialist will say this.

The UK charity The Daisy Network was established for women with prem menopause. This medical advice on HRT is there. The charity is run by some of the most qualified menopause gynaecologists in the UK.

Bookist · 26/08/2023 11:03

On my peri menopause journey I saw five separate GPs. They knew virtually nothing about HRT or the menopause, one admitted 'we aren't taught about it at medical school'. I went on to see the three top menopause specialists in the country, at the time. They all said that blood tests are irrelevant and that they diagnosed and prescribed according to symptoms. However, they all agreed that p/mol levels of 800+ was often necessary to fully alleviate symptoms in many women. Some women just need more it's as simple as that.

Davina Shouty and Mariella Hardup Frostrup are just desperately scrabbling to remain relevant and turn a buck.

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